Tuesday, August 14, 2012

Get an intrathecal, not an epidural

This past Sunday I was visiting with a friend at church who is a midwife. We got talking about natural childbirth, which we are both pretty passionate about. Among other things, I mentioned my recent experience delivering an 11 lb. baby naturally, and how I'd heard that having an epidural actually makes it impossible to deliver big babies vaginally. She confirmed this. I then talked about how I'd requested an intrathecal (instead of an epidural) during my first labor, and now looking back I realize that if I had had an epidural, I would almost definitely have ended up with a C-section (baby was almost 9 lbs.); and I wondered why more doctors don't push intrathecals over epidurals.

Well for one, as this friend told me, epidurals are more expensive and so anesthesiologists get paid more for administering epidurals over intrathecals. According to her, intrathecals are considered "outmoded" by many doctors, and so are not even presented as an option anymore. The only way I personally came across this pain management option was that during my first pregnancy my midwives presented me with a book titled "While Waiting." Even in that book, all it really says about risks of intrathecal over epidural is that "Current research suggests that the incidence of need for forceps or vacuum extraction or Caesarean delivery is about the same for women receiving intrathecal anesthesia compared to those receiving a regular epidural."

So what's the difference? What initially attracted me to the intrathecal over the epidural (though I was planning on a natural delivery, I wanted to have an acceptable pain relief option available should I need it), was that the intrathecal is more likely to allow the woman to move around and aid in pushing. An intrathecal numbs the pain without affecting the muscles. The drawback? An intrathecal typically only lasts for 2-3 hours. For the woman who wants total pain relief during labor, obviously the intrathecal is not going to do it for her. But for the woman who is willing to labor naturally for as long as possible but wants to keep the option open for temporary pain relief through the most difficult part of labor (being transition and pushing), the intrathecal makes a whole lot more sense.

One drawback that epidurals are notable for is that they hinder the laboring woman's ability to feel and listen to her own body's cues to push. I knew this, and I wanted to avoid being tied to my bed during labor. I wanted to be an active participant in the birth of my child.

So why is the epidural, then, the "drug of choice" for pain management during labor? Even if women are aware of the choice to have an intrathecal, they might be dissuaded by their doctor by the fact that an intrathecal begins to wear off after a couple of hours. This fact is viewed as a bad thing by many laboring women, who have been conditioned to believe that all pain is bad and traumatic and should be avoided. I don't like pain; even mild discomfort tends to make me irritable. But I also have come to believe that all pain is not created equal. And in the case of childbirth, the pain which accompanies contracitons and pushing is good pain, productive pain. And with all three of my deliveries, I have strived to use my pain, to embrace it, to make it work for me. And I have been rewarded with three vaginal deliveries, two of which were completely medication free (aside from receiving antibiotics in early labor for Group B Strep). I won't say it was easy, as it was quite the opposite; but the reward-- for me-- was the avoidance of unnccessary C-secitons due to the inability to push out my big babies.

So where did the intrathecal come into play? During my first pregnancy, my baby was overdue. I requested to be induced. To make a long story short, being on-and-off the pitocin for 30+ hours and getting very little sleep in all that time, by the time I got to the transition stage of labor I was exhausted. Up to this point, I'd been managing my labor pain pretty well; but I can tell you after experiencing both, the pain of a natural contraciton versus the pain of an induced contraction are so very different. Chemically, I believe that when contracitons are induced, the body does not have the same embracive response as it would to natural labor contractions. Also, induced contractions follow a different "rhythm" than natural contractions, often occurring one on top of the other rather than being spaced out with natural rest periods in between.

So, I got to the point where I knew I needed to rest before I had to push my baby out. I got out of the tub and into the bed, and before long the anesthesiologist arrived to administer my medication. I shudder to think what might have transpired had I gone into labor with no birth plan and having done none of my own research on my pain management options. As it was, I had written into my birth plan to get the intrathecal, so that was what he was prepared to give me.

The relief was almost immediate. I slept for two blissful hours. I might have slept even longer, but I was suddenly awakened by my pain beginning to return, and I realized that I had an irresistible urge to start pushing. I pushed the call button and alerted the nurse, who in turn alerted my midwife. The nurse helped me through the first few pushes before the midwife got there. I pushed my baby out in about eleven minutes, which is-- statistically speaking-- quite fast for a first-time delivery.

My baby weighed in at 8 lbs. 15 ounces. A weight which-- if most doctors knew I was going to deliver such a big baby before the fact-- would have recommended me for an automatic C-section merely judging by my petite size (5 ft. 2"). It seems really silly to me now that this would be the case, considering I have managed to vaginally deliver a baby weighing over 11 lbs. 9 lbs in comparison seems absolutely tiny.

So what led to this erroneous wide-spread belief that big babies cannot be delivered vaginally? You can come to your own conclusions, but personally, I'll blame it on the epidural.

And what's the take-home message of the whole post? To sum it up: If you're going to use pain management to get through labor, please please please have a heart-to-heart with your doctor or midwife about trying the intrathecal. And refer them to this blog post. Because doctors and women need to become more educated on the subject of appropriate and effective pain management while still facillitating vaginal deliveries and decreasing the number of unneccessary C-sections.

Sunday, August 5, 2012


Okay, I can't sleep. I have managed to thoroughly freak myself out.

A couple weeks ago, I began planning for Z's birthday party this coming weekend. Traditionally, we have had an outdoor party involving water. This year, I also decided to serve roasted hot dogs and homemade snow cones (using my blender to shave the ice).

I am also attempting to make a red velvet cake from scratch, because when I asked Z what kind of cake he wanted for his birthday, he said "red." Red is his favorite color.

Originally we'd planned to just have a few families over to our place; we'd all just hang out on the big lawn in front of our apartment, throw a few water balloons... But then, I thought why not make it more than just a birthday party; here was an opportunity to entertain a number of friends whom we've been intending to have over all summer and here's our last chance! We could put out a slip-n-slide, maybe get a large-ish wading pool, a few squirt guns, and of course the water balloons (because G decided two years ago that it should be a tradition to have water balloons at all of Z's birthday parties).

So I called up my mother-in-law and asked if we could have the party at their place, to which she graciously agreed (she's a generous soul herself).

At this point, I confess I got carried away (and Nick didn't stop me like he usually does-- he got a little carried away, too, though he probably won't admit it). I thought about the few families at church who have invited us to parties at their homes. And there were a couple of new families we wanted to get to know better. And then I tried to think of who the boys were good friends with and wanted to invite them. And then of course there's local family members who must be included. I had people I wanted to invite, and Nick had people he wanted to invite (and there were a few families on both our lists).

I made the invitations this morning and Nick and I handed them out at church today. We had twelve invites; nine were delivered (a few families were not there, and maybe it's just as well).

So, tally the potential guests (including us and familiy):

A=Adult; C=Child; B=Baby (under 2)


That's 23 adults, 25 children, and 9 babies. 57 total.


It's the larger families that are doing us in...

Of course, as I told Nick, it's likely not everyone will actually come, and I'm estimating the actual number of guests to be more like 30 (which is still a lot). But then Nick pointed out that it's also possible that everyone will come.

So now I don't know which to fear more: the thought that no one will come and that all my effort will be wasted; or that everyone will come, chaos will ensue, my cake will come out disastrous, some kid will light his clothes on fire, and the motor on my blender will die halfway through blending the ice for the snow cones leaving some very sad children snow-cone-less (heaven forbid).

Also, when I told my mother-in-law over the phone how many people we'd invited, I think I might have given her a near-heart-attack. I really should not be doing this to her (and I wouldn't blame her if she never let me throw a party at her house again).

Perhaps this whole thing was not too well thought through...

But, the ball's rolling now, so better roll with it!

Saturday, August 4, 2012

Five months

C is five months today (we'll see if I actually get this posted on the same day I start to write it).

He's pretty close to rolling over, but hasn't quite worked it out yet. He's getting to be quite "talkative," and his smiles are contagious. He likes to play with and suck on his hands, his shirt, his feet, the burp rag, or anything else he can get into his mouth. He seems to be much more orally stimulated than either of my other boys.

He spends a lot of time in the pack-n-play when he's awake, because it's too dangerous to leave him on the floor alone with Z around. Z is constantly trying to "wrestle" with him, and has even laid on him a few times *gasp* But he has somehow survived, despite my apprehensions.

He loves to be outside. He's pretty content to let just about anyone hold him right now, though I expect that will change at some point in the next few months.

I've eliminated most dairy from my diet now (yes, I miss it), and it really seems to be helping. C hasn't had a bad rash in almost a month, and he no longer screams in pain when he has a poopy diaper (a blessing and a curse, since it's not so easy to tell anymore when he needs a diaper change). He also is spitting up less than he was before, and is generally easier to get settled in at night (when the teething isn't bothering him too much). Makes me wish I had thought to try eliminating dairy when I was nursing Z; maybe he wouldn't have been so fussy and colicy all the time if I had (maybe he'd even be happier now).

So, a word of advice to any of you mothers out there dealing with colicy breastfed babies: try cutting the dairy. It might just save your sanity-- and your little one a lot of unneccessary pain. (wish I could go back in time to when I was a baby and tell this to my mom, haha)

Thursday, August 2, 2012

Good Ol' Macaroni and Cheese

Most times growing up (once we were old enough to be left alone), whenever my parents went out together at dinner time, my mom would leave a couple boxes macaroni and cheese on the kitchen counter for an easy meal that I or one of my siblings (she usually called on one of us before she left) could fix for the rest of the bunch. I took my share of turns at this task.

Macaroni and cheese should be foolproof, right? And for the most part it was; but my siblings will probably remember as well as I, there were a couple times I got it wrong-- really wrong.

Once, I forgot to drain the water before adding the cheese powder. I'll leave the rest of that story up to your imagination.

Another most memorable time was when I decided to add salt to the pot, per the box's suggestion ("1 tsp. salt optional"). Only I somehow read "1 Tbsp." instead. So, since I was fixing a double recipe, I added 2 Tablespoons salt and happily stirred away.

At the table, I dished out my siblings' plates first (as a good big sister should) and one of my brothers took the first bite and immediately complained that it was too salty. "Oh come on," I said (perhaps not verbatim, this was a long long time ago). "I just added a little salt, it's not that bad." Eventually, I settled in to eat myself and took a bite. "Okay," I confessed. "You're right. Guess I'll have to heat up some cans of chilli for dinner instead."

As I've grown into adulthood, first going to college and then settling into married life and raising my children, macaroni and cheese is still my go-to quick and easy meal at the end of a stressful, busy day. I know, it's really not that good for me, or for my family. But I figure, as I generally feed my family healthy foods, I can afford to "splurge" once in a while. Someday, too, I'll try my hand at mac-n-cheese from scratch; but the boxed stuff is so much cheaper and we keep buying it in bulk at caselot sales, so I feel obliged to keep making it the easy way.

But I don't just fix the same-old recipe over and over again. I like to experiment when I cook, and the macaroni and cheese dinner has not escaped my efforts to continually "shake it up" and make it new and more interesting again (though I have never again tried adding salt after that first failed experiment).

I've added hot dogs (learned that one from my mother). I've added tuna. I've added mushrooms. Peas. Carrots. Ground beef. Just this afternoon, I threw in a can of diced tomatoes. I've made it without milk. I've made it without butter. I've baked it in a casserole dish with bread crumbs and parmesan cheese sprinkled on top.

And it's probably one of the first things my kids will learn to cook on their own, for those times when Nick and I leave them for the evening to fend for themselves.